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Caring, Character & Calling: Finding Meaning in the Details

May 5, 2021

Did you ever have a teacher who changed your course or your life? Someone whose habits, actions, insights and integrity made you want to follow in their footsteps? Dell Medical School students share personal stories of profound influencers in this blog series.

All members of the Dell Medical School community are welcome to submit stories of teachers or mentors whose character moved them and made a difference in their development. This story is shared by Julianna Khoury, student at Dell Med.

The social history. Asking for pronouns. Sitting down with your patient.

These are not revolutionary advances in medicine being taught to us. They are a standard part of the history and physical you are taught as a first-year medical student — albeit frequently forgotten as the years go by and habits solidify. Medicine has evolved, or rather devolved, from house calls to rushed ten-minute encounters. The pressures of administration, patient quotas and productivity targets have taken away from the patient-physician relationship, which was once one of compassion and empathy.

As a medical student, even I caught myself becoming jaded. “Take no more than five minute," “we don’t need all of that information,” and “patients do not want to be asked their pronouns” were some of the more common statements I heard from various providers during my clinical rotations. This fast-paced, "few questions asked" tendency became my norm.

I arrived one morning to the federally qualified health clinic I was set to be at for the week during my women's health rotation. I introduced myself and greeted the staff who seemed a little on edge. “Today is going to be a long one," I heard them discussing among each other. Not knowing what was being discussed, I continued on setting up my workstation and preparing my notes for the morning’s patients. Shortly thereafter, a woman in scrubs walked in and greeted me, coffee and files in hand.

I walked in to the first patient room, determined to efficiently get my five-minute history and physical. I used my broken Spanish to get through the encounter, not wanting to take more time up from the busy clinic. I returned to the physician and presented the patient. “Did you ask about who she lives with?” she asked me. “No.” “Did you ask about any history of abuse?” “No.” “Does she feel safe in her relationship?” “I don’t know.” “Did you use a translator?” “No.” “Why not?” I had no answer. I was embarrassed and ashamed that I had failed to do what was taught to me so early on in my education. “Let’s go in together.”

I was in awe of what transpired. It was the details of the history — sitting down, using a translator, and asking personal questions that allowed us to get a better understanding of the patient’s health and well-being. It was the details of the exam — maintaining safety and comfort, being aware of the sensitive nature of the practice, ensuring that an ultrasound was checked first before allowing a woman to visualize her fetus for the first time. It was these details that caused me to stop and think that I could be this kind of physician. I could embody these character traits of sensitivity, patience, and awareness. I did not have to rely on the five-minute history and physical to navigate my day.

She later spoke to me passionately about her desire to start a practice for women from different countries who found themselves in the United States for one reason or another. It would be with the intention to create a global health community here in Texas. We got out late that day — just like the staff had foreshadowed — but I didn’t mind.

I only worked with her once and I am sure she does not remember me. However, her impact on me was immense. It carved out the physician I want to be and the practice I want to perpetuate. Although it may only take a few extra minutes, the little details are important and the compassion that comes with those few extra minutes does not go unnoticed. Those details are what should continue to be the foundation of medicine.

The Kern National Network for Caring & Character in Medicine (KNN) is a national network of seven medical schools dedicated to advance caring and character in medicine with the goal of promoting human flourishing. Guided by the principles of caring and character, the KNN provides a framework for training physicians, strengthening joy in medicine and improving health to promote human flourishing within, across and beyond the medical profession to positively impact individuals and communities in our society.

This initiative was made possible through support from the Kern National Network for Caring & Character in Medicine through an investment from the Kern Family Trust and Kern Family Foundation.